Abstract
The maxilla-first approach has been the standard orthognathic sequence for many years,
however, with the evolution of rigid internal fixation and to eliminate any errors
that could be encountered during preoperative bite registration, the mandible-first
approach has become an effective treatment modality for bimaxillary orthognathic surgery.
Would the maxilla-first or mandible-first orthognathic sequence in bimaxillary orthognathic
surgery result in more maxillary stability in patients with skeletal class III malocclusion?
Twenty-four patients with skeletal class III malocclusion were selected from the outpatient
clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo
University. Patients were randomly divided into two equal-sized groups: the maxilla-first
approach (group I), and the mandible-first approach (group II). All patients underwent
cone-beam computed tomography before, immediately after (P1), and 6 months after surgery (P2). Virtual planning included designing the virtual cuts and
the intermediate and final splints. Both splints were three-dimensionally printed.
In both approaches, hard and soft tissue landmarks were used as reference points to
evaluate maxillary stability, which was calculated by subtracting P2 values from P1
values. All measures were statistically evaluated as numerical values of means and
standard deviations. The differences between the radiographic measurements of the
two groups were not statistically significant except for the soft tissue inclination
at the nasal tip. The mandible-first approach in bimaxillary orthognathic surgery
is a reliable method for achieving high maxillary stability.
Keywords
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Article Info
Publication History
Published online: October 12, 2021
Accepted:
October 6,
2021
Identification
Copyright
© 2021 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
